Local Government Grant Applications

America 250 NC

Department of Natural and Cultural Resouces
America 250 NC Local Grants: County Committees Application

For Certified America 250 NC Community Partners
Please review the instructions prior to starting this application: America 250 NC County Committee Grant Instructions
Project Title*
Applicant Type *
Request Amount
Request amounts are defaulted to $10,000
Applicant/Project Sponsor

The lead applicant will be the fiscal agent for the project and will be responsible for final reporting.
Contact Name*
Organization *
Job Title
E-mail*
example@example.com
Website
America250@nc.dncr.gov
County*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Federal Tax ID/Employer Identification Number*
Need Help? Visit https://www.irs.gov/businesses/small-businesses-self-employed/lost-or-misplaced-your-ein
Project Director

The project director will lead the day-to-day operations of the project and will ensure that the project is kept on time, within budget, and that all deliverables are met. The project director will be the primary point of contact for the American 250 NC grants officer.
Project Director Name *
Organization *
Job Title *
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Budget Officer

The Budget Officer will be the chief fiscal officer for the lead applicant and will be responsible for ensuring grant funds are spent according to the grant application and all applicable state laws.
Budget Officer Name *
Organization *
Job Title
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Authorizing Officer

If different from above
Authorizing Officer Name
Organization
Job Title
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Project Summary

See instructions prior to completing this section.
Type of Project *
Please see instructions for detailed description of eligible projects
Project Summary *

Briefly summarize the applicant, and the project, including subject matter and purpose. This description may be used in publicity. 0/250
America 250 NC Themes*

Explain how this project relates specifically (not tangentially) to the themes of America 250 NC. https://www.america250.nc.gov/about/commemorative-themes0/500
Project Narrative*

Word limits indicate the maximum number of words allowed, not the minimum required. See instructions prior to completion. 0/1500
Does your project propose any waysides, markers, or public murals?

YesNo
Number of Waysides, Markers, or Murals *
Map Coordinates *
Use Google to provide the latitude and longitude. If you have more than one, separate with semicolons.
Do you have written permission from the property owner(s) to place your wayside, marker, or mural in this/these locations?*

YesNo
Will the project have an additional external review?*

YesNo
External Review Process
Please describe the process. What is your plan to ensure the accuracy of the historical information?
Communications Plan *

See instructions prior to completion. 0/500

Project Deliverables/Impact
Deliverables/Expected Outcome *

See instructions prior to completion. 0/500
Measurement of Success*

See instructions prior to completion. 0/500
Participation and Access*

See instructions prior to completion.0/500
Longevity/Lasting Impact *

See instructions prior to completion. 0/250
Partnerships *

See instructions prior to completion. 0/250
Project Timeline Summary *

See instructions prior to completion. 0/500
Budget Summary *

0/500
Download Budget Form
Budget Form*

Please name your file "Budget_Form_OrganizationName." PDF Only. 1 MB limit.
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Conflict of Interest Policy/Ethics Statement *

Please name your file "Conflict_of_Interest_OrganizationName." PDF Only. 1 MB limit.
Cancelof
Property owner permission or endorsement for wayside, marker, or mural.*

More than one file is supported. PDF Only. Please name your file with the appropriate description_PropertyPermission (e.x. Mural_PropertyPermission). 2 MB limit.
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America 250 NC County Committee Resolution

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Product or Services Quotes

More than one file is supported. PDF Only. Please name your file "Product_Services_Quote_OrganizationName." PDF Only. 2 MB limit.
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Should be Empty:

America 250 NC Local Grants: County Committees Application

Applicant/Project Sponsor

Project Director

Budget Officer

Authorizing Officer

Project Summary

Project Deliverables/Impact